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Autonomic Dysreflexia

Autonomic Dysreflexia

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Published by: E on May 14, 2009
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1Elisabeth Fandrich10/08/08524 K,C,TAutonomic DysreflexiaAutonomic dysreflexia is a condition that is potentially life-threatening. Theautonomic nervous system overreacts to excessive stimulation of the nerves belowthe level of the spinal cord injury. Normally, when the autonomic nervous systemresponse is activated, the mediating parasympathetic nervous system response istriggered. In the case of the patient with a spinal cord injury, the parasympatheticnervous system response is blocked at the site of the injury.Severe hypertension occurs as a result of the vasoconstriction elicited by theautonomic nervous system response. This severe hypertension can lead to seizuresor even a stroke if it is not controlled and reversed as soon as possible. The body itself will try to counteract the hypertensive state by vasodilation. Thiswill only occur above the location of the spinal cord injury. The result of this is thatthe lower body has a blood pressure that is very high, and the upper body has alower blood pressure. The vagus nerve is stimulated by the high blood pressurewhich triggers bradycardia. Rather than stimulating vasodilation like it normallywould, the signal never reaches the vessels lower than the site of the injury.Autonomic dysreflexia can be triggered by any strong nerve stimuli below the site of injury, but the most common causes are as follows: bladder distention, constipation,renal calculi, ejaculation, uterine contractions, skin rash, pressure sores,thrombophlebitis, enemas, exposure to hot/cold stimuli, gastric ulcers,ormenstruation.When a patient exhibits signs of autonomic dysreflexia, a quick assessment must bedone, catheters must be inspected for kinks, bladder distention, constipation, etc. The stimulus that has triggered the autonomic dysreflexia must be discontinuedimmediately.Manifestations of autonomic dysreflexia are paroxysmal hypertension (no knownreason), pounding headache, blurred vision, bradycardia, diaphoretic above site of spinal cord injury, piloerection, nasal congestion, nausea, and papillary dilation. Treatment for autonomic dysreflexia is to remove the causative stimulus, andadminister medications to lower blood pressure.

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